Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Review[Legal aspects of video registration during operations--the digital operating room assistant: opportunity or threat?].
Video registration in hospitals is becoming increasingly frequent and an increasing number of surgical procedures are performed with the help of video imaging. The Technical University of Delft is developing a safety system that will use video images to directly inform medical staff of technical problems during surgery so that necessary adjustments can be made in time: the digital operating room assistant. However, the saving of video images is legally considered to be processing of personal data. ⋯ In addition to the doctor and the patient, in certain circumstances, access to the video recordings may also be granted to the Health Care Inspectorate and, to the Public Prosecutor. Covert video recording of an employee is a breach of privacy and essentially punishable by law. Video recordings may not themselves be used to assess the performance of the surgeon involved.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Facial transplantation: an overview of 8 of the 13 operations].
Composite tissue allotransplantation (CTA) is a new development in reconstructive surgery that makes it possible to use identical tissue to repair large mutilating deformities, to the face for example. Until now, 13 face transplants have been performed worldwide. The functional and aesthetic results are encouraging. However, the lifelong immunosuppressive therapy necessary to prevent rejection has considerable side effects.
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As paracetamol is widely used and easily available acetaminophen auto-intoxication is frequently seen. In the majority of patients no complications will occur, but in a small group it may lead to liver damage and death. Children are less susceptible to complications than adults. ⋯ This nomogram has only been validated in adults, but nevertheless is also used in children. Gastric lavage should not be implemented, active charcoal can be given to a conscious cooperative patient within 1 hour of ingestion of acetaminophen. A multidisciplinary approach to treatment is needed with the collaboration of an emergency physician, paediatrician or internist, pharmacist and also a child psychiatrist.
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Ned Tijdschr Geneeskd · Jan 2011
Review[Physical examination of patients with acute abdominal pain].
Reliable physical examination of patients presenting with acute abdominal pain and tenderness is necessary for identifying serious causes on the one hand, and for preventing further unnecessary imaging on the other. If acute appendicitis or peritonitis is suspected, positive palpatory findings like rigidity and guarding are helpful diagnostic indicators, whereas negative palpatory findings have little value in excluding these conditions. ⋯ Visible peristalsis strongly argues for small bowel obstruction, but this sign is rarely present. Digital rectal examination appears to have no added diagnostic value for appendicitis, peritonitis, or small bowel obstruction.
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Ned Tijdschr Geneeskd · Jan 2011
Comparative Study[Hospital standardised mortality ratio (HSMR): adjustment for severity of primary diagnosis can be improved].
To study the impact of casemix variations within primary diagnostic groups on hospital standardised mortality ratios and to improve the current HSMR model. ⋯ The HSMR model currently used in the Netherlands does not adequately adjust for casemix differences at the level of ICD-9 primary diagnoses. A model using a severity classification of ICD-9 codes based on actual Dutch hospital mortality allows for a better, albeit not perfect, adjustment. We recommend implementation of the 'Dutch' severity classification in order to improve the HSMR model.